Note :

1. All items must be legibly written.

2. Price offers exceeding the Approved Budget for the Contract (ABC) shall be automatically

disqualified.

3. Total price quotation shall be inclusive of taxes such as but not limited to VAT, income tax,

local tax and other levies.

4. Price quotation will be valid for One Hundred Twenty (120) calendar days from date of

opening of sealed quotation.

5. The price offered shall not be subject to any increase for whatever reason including in cases of

devaluation/inflation during the entire duration of the contract.

TO: ATTY. MANOLO C. SY

Assistant Commissioner

Chairperson, Bids and Awards Committee

Sir:

I hereby submit my quotation on the items as indicated above, along with the required documents

as per attached TECHNICAL SPECIFICATIONS for the Acquisition of Secure Sockets Layer

(SSL) Certificates for the protection of Commission’s website:

QUOTE/OFFER:

Particular Amount

Amount in Words _______________________________________________________________

______________________________________________________________________________

We understand that you are not bound to accept the lowest or any Quotation you may receive.

_____________________________________

Name of Firm/Offeror

_____________________________________

Printed Name and Signature of Representative

_____________________________________

Address

______________________________________

Telephone No. / Cellphone No. / e-mail address

______________________________________

Date

Omnibus Sworn Statement

REPUBLIC OF THE PHILIPPINES )

CITY/MUNICIPALITY OF ______ ) S.S.

AFF IDAV IT

I, [Name of Affiant], of legal age, [Civil Status], [Nationality], and residing at [Address of

Affiant], after having been duly sworn in accordance with law, do hereby depose and state that:

1. Select one, delete the other:

If a sole proprietorship: I am the sole proprietor of [Name of Bidder] with office address

at [address of Bidder];

If a partnership, corporation, cooperative, or joint venture: I am the duly authorized and

designated representative of [Name of Bidder] with office address at [address of Bidder];

2. Select one, delete the other:

If a sole proprietorship: As the owner and sole proprietor of [Name of Bidder], I have

full power and authority to do, execute and perform any and all acts necessary to

represent it in the bidding for [Name of the Project] of the [Name of the Procuring

Entity];

If a partnership, corporation, cooperative, or joint venture: I am granted full power and

authority to do, execute and perform any and all acts necessary and/or to represent the

[Name of Bidder] in the bidding as shown in the attached [state title of attached

document showing proof of authorization (e.g., duly notarized Secretary’s Certificate

issued by the corporation or the members of the joint venture)];

3. [Name of Bidder] is not “blacklisted” or barred from bidding by the Government of the

Philippines or any of its agencies, offices, corporations, or Local Government Units,

foreign government/foreign or international financing institution whose blacklisting rules

have been recognized by the Government Procurement Policy Board;

4. Each of the documents submitted in satisfaction of the bidding requirements is an

authentic copy of the original, complete, and all statements and information provided

therein are true and correct;

5. [Name of Bidder] is authorizing the Head of the Procuring Entity or its duly authorized

representative(s) to verify all the documents submitted;

6. Select one, delete the rest:

If a sole proprietorship: I am not related to the Head of the Procuring Entity, members of

the Bids and Awards Committee (BAC), the Technical Working Group, and the BAC

Secretariat, the head of the Project Management Office or the end-user unit, and the

project consultants by consanguinity or affinity up to the third civil degree;

If a partnership or cooperative: None of the officers and members of [Name of Bidder] is

related to the Head of the Procuring Entity, members of the Bids and Awards Committee

(BAC), the Technical Working Group, and the BAC Secretariat, the head of the Project

Management Office or the end-user unit, and the project consultants by consanguinity or

affinity up to the third civil degree;

If a corporation or joint venture: None of the officers, directors, and controlling

stockholders of [Name of Bidder] is related to the Head of the Procuring Entity, members

of the Bids and Awards Committee (BAC), the Technical Working Group, and the BAC

Secretariat, the head of the Project Management Office or the end-user unit, and the

project consultants by consanguinity or affinity up to the third civil degree;

7. [Name of Bidder] complies with existing labor laws and standards; and

8. [Name of Bidder] is aware of and has undertaken the following responsibilities as a

Bidder:

a) Carefully examine all of the Bidding Documents;

b) Acknowledge all conditions, local or otherwise, affecting the implementation of the

Contract;

c) Made an estimate of the facilities available and needed for the contract to be bid, if

any; and

d) Inquire or secure Supplemental/Bid Bulletin(s) issued for the [Name of the Project].

9. [Name of Bidder] did not give or pay directly or indirectly, any commission, amount, fee,

or any form of consideration, pecuniary or otherwise, to any person or official, personnel

or representative of the government in relation to any procurement project or activity.

IN WITNESS WHEREOF, I have hereunto set my hand this __ day of ___, 20__ at

____________, Philippines.

____________________________________

Bidder’s Representative/Authorized Signatory

[JURAT]

* This form will not apply for WB funded projects.